21 Disease activity and body mass index in juvenile idiopathic arthritis: is the truth revealed?

Abstract Background Active disease in chronic rheumatic diseases in adults seems to be associated with overweight and obesity [1]. Juvenile Idiopathic Arthritis (JIA) is the most frequent rheumatic disease in children. The relationship between body mass index (BMI) and disease activity in JIA patients is less studied. Objective To determine the link between BMI and disease activity in JIA patients. Methods We conducted a cross-sectional study including 35 JIA patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria. For each patient, we collected the following data: age, age at the onset of JIA, disease duration, patient global assessment (PGA), visual analogic scale (VAS), tender joint count (TJC), swollen joint count (SJC), disease activity using the Juvenile Arthritis Disease Activity score (JADAS), and therapeutic management. The weight and height were measured for each patient. The BMI was calculated and interpreted according to the World Health Organization classification. We also measured C-reactive protein (CRP) and Erythrocyte sedimentation rate (ERS) level. Results We included 15 boys and 20 girls. The mean age was 12.2 ± 3.61 years. The mean age at the onset of the disease was 8.65 ± 3.83 years. The mean disease duration was 4.1 ± 3.29 years. The mean PGA and the mean VAS were 3.4 ± 3.02 and 3.37 ± 2.92, respectively. The mean TJC and the mean SJC were 1.48 ± 1.69 and 0.61 ± 0.77, respectively. The mean CRP and ESR were 7.51 ± 11.85 mg/l and 18.88 ± 15.53 mm, respectively. The mean JADAS was 7.58 ± 6.3. Twenty-four patients were under non-steroidal anti-inflammatory drugs (69%), 10 patients were under methotrexate (34%), and 5 patients were under TNFα inhibitor (14%). The mean BMI was 19.94 ± 5.46 kg/m². Fourteen patients were underweight (40%), 15 patients had a BMI in the normal range (43%), 4 patients were overweight (11%), and 2 patients were obese (6%). Underweight patients had higher PGA, higher CRP level, higher tender joint count (TJC), and higher JADAS compared with overweight and obese patients, but without significant difference (PGA: 2.97 ± 2.6 vs 2 ± 1.89, p = 0.4; CRP: 7.54 ± 15.09 vs 4.25 ± 4.19 mg/l, p = 0.6; TJC: 1.7 ± 1.56 vs 1 ± 0.8, p = 0.3, and JADAS: 6.3 ± 6.18 vs 2.98 ± 2.24, p = 0.1). No correlations were found between BMI and the following parameters: TJC, SJC, EGP, CRP, ESR, and JADAS. Conclusion Data about associations between underweight, obesity, and disease activity in JIA are conflicting. Some authors suggested that active disease is associated with adiposity [2]. Others showed that underweight patients had higher disease activity [3]. Although there was no significant difference, our study is consistent with Neto et al. study. Indeed, active disease seems to affect the child’s appetite and weight gain leading to cachexia [3]. Other studies are needed to confirm these results. References 1. Bindesbøll C, Garrido-Cumbrera M, Bakland G, Dagfinrud H. Obesity Increases Disease Activity of Norwegian Patients with Axial Spondyloarthritis: Results from the European Map of Axial Spondyloarthritis Survey. Curr Rheumatol Rep. 2020; 22(8):43. 2. Diaz-Cordovés Rego G, Núñez-Cuadros E, Mena-Vázquez N, Aguado Henche S, Galindo-Zavala R, Manrique-Arija S, et al. Adiposity Is Related to Inflammatory Disease Activity in Juvenile Idiopathic Arthritis. J Clin Med. 2021; 10(17):3949. 3. Neto A, Mourão AF, Oliveira-Ramos F, Campanilho-Marques R, Estanqueiro P, Salgado M, et al. Association of body mass index with Juvenile Idiopathic Arthritis disease activity: a Portuguese and Brazilian collaborative analysis. Acta Reumatol Port. 2021; 46(1):7–14.


Background
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. JIA likely has a complex aetiology, with multiple genetic and environmental factors contributing to its development. Existing data on associations between maternal and early childhood exposures and JIA is rare. Previous studies showed potential role for prematurity, number of siblings and infections.

Objectives
The aim of our study is to assess maternal and early childhood exposures in patients with JIA.

Methods
Mothers of children with JIA followed in rheumatology department were asked about maternity related data as well as the course of perinatal period of the child with JIA based on the International League of Associations for Rheumatology (ILAR) criteria. Exposure information from birth included: Maternal factors (age when they had the first child, age when they had the child with JIA, plurality (singleton, twin/multiple gestation), number of prior fetal losses, number of prior births; delivery method (vaginal, cesarean section)) and also information about birth weight (low (<2500 grams), normal (2500-4000 grams), excessive (4000þ grams)); size for-gestational-age and gestational age (preterm, normal term, post term) and postpartum complications.

Results
Thirty children (sixteen females and fourteen males) with JIA were included. The most common type of JIA was enthesitis-related in 13 cases, then oligoarthritis in 8 cases, polyarthritis without rheumatoid factor in 4 cases, polyarthritis with positive rheumatoid factor in 2 cases and psoriatic arthritis in 3 cases. The mean age of the mothers was 27.1 years [22-40] when they had their first child and 30.27 years [22-42] when they had their child with JIA. They were nulliparous in 40% of the cases. All of the children were from a singleton pregnancy. Thirty percent of the mothers had at least one prior fetal loss before they had their child with JIA. During their pregnancy with their child with JIA, five mothers had pre-eclampsia and two of them had gestational diabetes. None of them smoked during the pregnancy. Only 2 children had preterm birth. Birth weight was normal (2.500-4.000 grams) in 24 cases, low in 3 cases (<2.500 grams) and above normal (>4000 grams) in 3 cases. Size for gestational age was normal in all cases. Nineteen mothers had vaginal delivery and eleven had cesarean section. Neonatal complications were noted in 7 cases who needed to be admitted to neonatal intensive care unit (1 for hypoglycemia, 1 for jaundice, 2 for infection, 1 for respiratory distress and two because of preterm birth). Maternal complications were noted in four cases: 2 postpartum hemorrhage and 2 postpartum infections.

Conclusion
Our study assessed maternal and early childhood exposures in patients with JIA. Further studies are required to explore associations between these factors and the occurrence of the disease for a better knowledge of etiologies of JIA and for a possible prevention from this pathology.

Background
Although ankle and foot involvements are common in juvenile idiopathic arthritis (JIA), they are often neglected. Hip involvement, also common in JIA, may affect these joints by creating a chronic imbalance of the musculoskeletal system. However, no studies have been published on this subject. Objective We aimed to describe ankle and foot impairment in a cohort of patients with JIA and to study the correlation between these impairments and the presence of hip arthritis. Methods A monocentric cross-sectional study was conducted including JIA patients fulfilling the 2001 ILAR criteria. Patients with congenital malformation of the ankle or foot or with any other foot impairment due to a disease other than JIA were not included. Foot examination was performed on bare feet both in supine and standing position. We completed with an analysis of footprint with a podoscope and shoes examination. Patients were divided in two groups depending on the presence or the absence of hip arthritis on pelvis X-ray, hip ultrasound or hip magnetic resonance imaging.

Results
We included 35 patients (M/F ¼ 15/20). Hip arthritis was noted in 45.7%. Oligoarticular (43.8%) and enthesitis-related arthritis (25%) were the most frequent form of JIA. Functional complaints related to foot and ankle were reported in 34.3% of cases. The pain was the most frequent symptom (91%), mainly in the hindfoot and ankle (50%). Foot pain was more frequently encountered in the absence of hip arthritis (52%, vs 31.2% in presence of hip arthritis). Physical examination revealed limitation of the talocrural joint in 20% of cases and feet tenosynovitis in 14.3% of cases. Achille tendon enthesitis was found in 8.6% of patients. These abnormalities were more prevalent in the absence of hip arthritis. Half of the patients had hindfoot deviation dominated by hindfoot varus (22.9%). In the group with hip arthritis, a hallux valgus was found in 14.3%, a supraductus of the 2 nd toe, and claw toe in one case each. An anomaly of the footprint was noted in 28 patients, including 11 in the group with hip involvement: 7 cases of cavus foot and 4 cases of flat foot. There were no correlations between foot or ankle anomalies with hip impairment apart from an association of flat foot with the absence of coxitis, and a leg length discrepancy more important in the group with hip arthritis.

Conclusions
Our study confirms the frequency of foot and ankle involvement as well as hip arthritis during JIA, hence the importance of their systematic screening even in asymptomatic children. Larger-scale studies would be necessary to evaluate with more precision the relation that there could be between hip and foot impairment. Background Active disease in chronic rheumatic diseases in adults seems to be associated with overweight and obesity [1]. Juvenile Idiopathic Arthritis (JIA) is the most frequent rheumatic disease in children. The relationship between body mass index (BMI) and disease activity in JIA patients is less studied.

Objective
To determine the link between BMI and disease activity in JIA patients.

Methods
We conducted a cross-sectional study including 35 JIA patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria. For each patient, we collected the following data: age, age at the onset of JIA, disease duration, patient global assessment (PGA), visual analogic scale (VAS), tender joint count (TJC), swollen joint count (SJC), disease activity using the Juvenile Arthritis Disease Activity score (JADAS), and therapeutic management. The weight and height were measured for each patient. The BMI was calculated and interpreted according to the World Health Organization classification.
We also measured C-reactive protein (CRP) and Erythrocyte sedimentation rate (ERS) level.

Results
We included 15 boys and 20 girls. The mean age was 12.2 AE 3.61 years. The mean age at the onset of the disease was 8.65 AE 3.83 years. The mean disease duration was 4.1 AE 3.29 years. The mean PGA and the mean VAS were 3.4 AE 3.02 and 3.37 AE 2.92, respectively. The mean TJC and the mean SJC were 1.48 AE 1.69 and 0.61 AE 0.77, respectively. The mean CRP and ESR were 7.51 AE 11.85 mg/l and 18.88 AE 15.53 mm, respectively. The mean JADAS was 7.58 AE 6.3. Twenty-four patients were under non-steroidal anti-inflammatory drugs (69%), 10 patients were under methotrexate (34%), and 5 patients were under TNFa inhibitor (14%). The mean BMI was 19.94 AE 5.46 kg/m 2 . Fourteen patients were underweight (40%), 15 patients had a BMI in the normal range (43%), 4 patients were overweight (11%), and 2 patients were obese (6%). Underweight patients had higher PGA, higher CRP level, higher tender joint count (TJC), and higher JADAS compared with overweight and obese patients, but without significant difference

Conclusion
Data about associations between underweight, obesity, and disease activity in JIA are conflicting. Some authors suggested that active disease is associated with adiposity [2]. Others showed that underweight patients had higher disease activity [3]. Although there was no significant difference, our study is consistent with Neto et al. study. Indeed, active disease seems to affect the child's appetite and weight gain leading to cachexia [3]. Other studies are needed to confirm these results.

Background
Foot deformities seem to be frequent in children with Juvenile Idiopathic Arthritis (JIA) [1,2]. These deformities can deeply affect the child's activity and alter his quality of life.

Objectives
To study the association between disease activity and foot deformities in JIA patients.

Methods
We conducted a cross-sectional study including patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria for JIA. For each patient, we collected the following data: age, disease duration, tender joint count (TJC), swollen joint count (SJC), Patient Global Assessment (PGA), Visual Analogic Scale (VAS), and therapeutic management. Disease activity was assessed using the Juvenile Arthritis Disease Activity score (JADAS). Foot deformities were assessed using an optical podoscope. C-reactive protein (CRP) and Erythrocyte sedimentation rate (ERS) levels were measured. Statistical analysis was performed using SPSS software.

Conclusion
Our study showed that foot deformities are common in JIA. Interestingly, these deformities are associated with a higher CRP level and a higher disease activity. These results suggest that an early screening of foot deformities is advisable in patients with active disease. Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Hip involvement is a common problem in JIA patients and is associated with functional disability and poor outcomes. Intensive therapy is required to avoid replacement surgery. With few studies in the literature, the predictive factors of hip involvement are still unknown.

Objectives
To identify the clinical, biological characteristic of patients with hip involvement and determine the risk factors associated. Methods A cross-sectional study including children with JIA according to the International League of Associations for Rheumatology (ILAR). The recorded data included sociodemographic features, disease characteristics (subtype disease, duration, and juvenile arthritis disease activity score (JADAS) as well as treatment modalities. Regarding coxitis, we collected radiographs, ultrasound (US), and magnetic resonance imaging (MRI) of the hip when performed. Coxitis was defined by clinical (limited range of motion) and/or radiographic findings (destruction, synovitis, bone marrow oedema).

Conclusion
Our study shows that long disease duration exposes to a higher risk of hip involvement in children with JIA. Active disease and biological